Begin reviewing and replying to peer postings/responses early in the week to enhance peer discussion. See the rubric for participation points. Participate in the discussion by asking a question, providing a statement of clarification, providing viewpoints with a rationale, challenging aspects of the discussion, or indicating relationships between two or more lines of reasoning in the discussion. Always use constructive language, even in criticism, to work toward the goal of positive progress. Peer 1 Topic 1 From the chapter The Changing United States Health Care System in your course textbook, using either the story of Wald’s efforts to improve the health status of impoverished immigrant communities or the story of how advanced practice registered nurses have struggled with their legitimacy within the health care delivery system, compare your own experience in nursing. Have there been challenges you have faced? If so, what strategies did you employ to overcome these challenges? How do you envision your career moving forward in advocating for your patients? Your community? Yourself? The struggle with legitimacy within the health care system still continues today. The stories of nurse practitioners and public health nurses are also connected by the ability to thrive and continue negotiations within a slow and subtle policy process (Mason 2016). I have seen that many nurse practitioners continue to find their way. I have seen where the nurse practitioners on a patient’s team may make an independent decision and the primary physician may come and discontinue the order. This can be very discouraging for up and coming nurse practitioner because they have the patient’s best interest at heart. Often times to overcome the challenges, we find it best to come together and discuss the patient’s treatment plan to make the best decision for the patient’s diagnosis and still continue to be an advocate for the patient. As I envision my career, I know that there will continue to be many obstacles that come may way. I have always tried to be an advocate for all my patients and sometimes the nurse is the only person that the patient can depend on. When patients come to the hospital, they voice their concerns to us with hope that we will communicate with the physician. Because we are our patient’s advocates, our advocacy will resonate throughout the community because they will brag on the treatment they received when we cared for them. As a nurse, it brings me great joy when I know that I have made a difference in someone’s life during my 12 hour shift. Many times, this joy may be the only motivation that I have to go back and conquer the next shift. I have seen so many things change, but many still remain the same. D. Mason, D. Gardener, F. Outlaw, E. O’Grady. Policy & Politics in Nursing and Health Care. 2016 7th edition. Elsevier Inc. 978-0-323-24144-1 Peer 2 As a seasoned nurse I feel that accountability is one of the issues that we are faced with in healthcare. We have always had an issue with our staff regarding call ins, however since Covid reared its ugly face we have had an influx of staff not holding themselves accountable in more ways than one. This issue stems from clerical staff, CNA, to nursing staff unfortunately. It seems that medical staff are not going into the nursing profession to make a difference, only to make a decent paycheck. While healthcare has numerous challenges, accountability is high on the list alongside long work hours and areas of short staffed. Denis states that Accountability regimes in healthcare systems thus face numerous challenges relating to the definition of a clear mandate in the form of specific goals and objectives, to the attribution of these mandates to skillful providers or organizations and to the design of incentives to support the accountability relationship and improvement (Denis, 2014). Nursing is a demanding profession that entails increased workloads, higher level acuity patients today and we are expected to perform safe and quality patient care with very limited staff. This is where professional accountability allows us to celebrate our success while providing safe effective patient care to our patients and admitting when we make mistakes every time. Many go on to say that accountability has become a major issue in healthcare, and I could not agree more with that statement. I feel like in order to encourage accountability, we as managers must hold our staff to the policies that we are governed by. We can not worry about staff threatening to quit as a result of holding them accountable for their actions and show other staff that we are setting a higher limit for our facilities. In order to advocate for our patients properly we must first know the needs of our patients and then focus on how we can meet those needs. Advocating is a strong aspect of my nursing career given my professional background in the medical field. I will always advocate for my patients and family regardless of the circumstances because that is the right thing to do as a nurse and as a person. Reference Denis J. L. (2014). Accountability in healthcare organizations and systems. Healthcare policy = Politiques de sante, 10(Spec issue), 811.